On a common day in Kachumbala, Uganda, dozens of African women are looking for a place to give birth. Their only option is to use a public building with relatively poor health conditions or to use their own houses. Under these conditions, it is predictable the high maternal and infant mortality rate among 160,000 people whose access to healthcare is almost zero. However, it is also the ideal context where architecture might be shown as a tool to solve low-quality space issues and improve health conditions.

Kachumbala And Its Critical Conditions for Maternity

In 2014, the conditions of neonatal and maternal mortality in Kachumbala were in a critical situation. The deteriorating conditions of the healthcare system, the weak infrastructure, the lack of medical supervision and the limited supply of energy are some of the reasons behind this issue. The only place available at that moment was a ward made up of two rooms in which functions had to work together(HKS Architects, 2019). That is, when expectant mothers were waiting for their turn, there were other women giving birth and some meters next to them, other people doing the paperwork corresponding to site management. To this is added the climate: dry and hot weather that creates conditions for the proliferation of bacteria.

In response, Kachumbala’s local municipality set a challenging goal for this year: to reduce the critical statistics through the provision of quality space in this remote place. No matter what the result is, it must provide a self-sufficient building based on passive design strategies that can thrive in a world without reliable sources of energy.

This kind of context is an ideal example of how crucial it is to understand the conditions and real needs of the local population. A task for which only a limited number of professionals are capable of working. To deal with such a relevant challenge, HKS Architects worked with Engineers for Overseas Development.

Kachumbala Maternity Unit by HKS - Sheet1
Original delivery room built in 1950’s_©(BBC News, 2017)

ABespoke Maternity Unit

The project considered the construction of a much larger building with a ward of at least nine beds, adequate offices for paperwork, and two main spaces for carrying out medical procedures. All of these are complemented by the provision of proper healthcare conditions. Energy supply is one of the main challenges, due to the remote location of the project. For this, the team proposed solar power for lighting and refrigerating the essential medication used by medical staff. As well as rainwater collection, which is also processed by a filtration system. Finally, there is an onsite pharmacy that is adapted to the inconstant power supply in the place.

Through these decisions and many others, the design team provided a building that can work perfectly as a self-sufficient building. This is especially highlighted by Flower, who stated that most of the year the building can “…effectively run as a net zero building”. This is also possible thanks to the inclusion of the community and the correct selection of available materials in the immediate context. 90% of these were produced by people and can be seen in the terracotta screens that shape the facades of the buildings. These screens ensure a proper passive shading system and appropriate ventilation.

Kachumbala Maternity Unit by HKS - Sheet2
General plan of the building and its architectural program distribution_©(HKS Architects, 2017)

Impacts in and out of the context.

Julie Wellik, the co-director of the social impact initiative by HKS architects explained that almost everything was built by hand, and, from the beginning, the lack of electricity was a crucial condition to consider(HKS Architects, 2019). As a result, even the handmade bricks were not fired as they normally are, but rather baked by solar radiation. Additionally, besides the community involvement and the environmental responsibility of this method, the impact on the community’s economic situation was an extra benefit impossible to ignore.

The design team’s consideration of the social aspect is crucial in terms of acceptance of the project. Flower recognized that this was crucial, as his experience allowed him to know how critical it is to prioritize local knowledge over external “alien technologies” that might not be accepted. Sustainability is achieved most effectively by avoiding the transfer of materials and tools from one side of the world to the other.

Finally, it is also a useful reference to understand the relevant role of the historical weight of knowledge in local communities. Additionally, it must relate to updated knowledge that is generated by a parallel international team that works equally as hard and does the same work as the first one. Moreover, the academy’s role is complemented through the participation of Cyfle Building Skills, which trained local laborers on the use of a press block machine created by a Ugandan university(Cyfle, 2022).

According to the report published by HKS architects(2019), the impact can be classified into three parts: (1) environmental, (2) human, and (3) business & community impact. The most relevant facts are the following:

1) In the first case, a “96% reduction in energy usage intensity compared to a typical US clinic in a similar climate”.

2) About the human impact, a “9.77 out of 10 patient satisfaction rating average”.

3) Finally, the unit can offer additional health services to the community.

Image 3_Local kid walking in front of the project’s shading system_©(Landers, 2019)

A wider perspective for facing social issues

Beyond the positive pragmatic consequences that this project has in this context, however, it is also pertinent to emphasize what this type of project means in the field of architecture. Projects like this are a turning point in the way how big architectural firms around the world approach architecture. HKS is an international firm of more than 1400 architects, and it is considered one of the most prominent firms nowadays. However, there is still an intention to focus on projects with a social purpose. This is done by playing a double role in society through designing in parallel a huge stadium on one side and a maternity unit on the other.

The ability to work as a network of international stakeholders is possibly even more significant. This is because it changes the outdated approach where a big global company develops a project as an alienated designer. Instead, the project’s richness was increased by an international team that was humble enough to accept existing know-how and incorporate local partners. Along with the community contribution that is already part of the project, its acceptance is also already the outcome of the process itself.

Community participation in artisanal brick production_©(HKS Architects, 2017)

Beyond the disciplinary goals.

In conclusion, this case study demonstrates how architecture can be understood as a technical skill that helps society. In consequence, every architect can be seen in the future as a tool for solving social issues through spatial solutions and the exchange of knowledge. In addition, this can contribute to a successful career if, even if the architectural firm becomes prominent worldwide, social responsibility is never neglected. An extrapolation of what Eduardo Galeano describes as a sentient approach to life. A way to live where intelligence is never separated from a sensitive understanding of reality, otherwise, knowledge will be used for nothing but individual benefits.


BBC News, 2017. Welsh workers build new eco-maternity unit in Uganda. [Online] Available at: https://www.bbc.com/news/uk-wales-41763342 [Accessed 22 October 2022].

Cyfle, 2022. Kachumbala Maternity Unit. [Online] Available at: https://www.cyflebuilding.co.uk/case-studies/uganda-2/ [Accessed 22 October 2022].

HKS Architects, 2017. By the People, for the People: Kachumbala Maternity Unit Opens in Uganda. [Online] Available at: https://www.hksinc.com/our-news/articles/by-the-people-for-the-people-kachumbala-maternity-unit-opens-in-uganda/ [Accessed 22 October 2022].

HKS Architects, 2019. Citizen HKS: A Powerful Agent for Change. [Online] Available at: https://www.hksinc.com/our-news/articles/citizen-hks-overview/ [Accessed 22 October 2022].

HKS Architects, 2019. HKS inc. [Online] Available at: https://www.hksinc.com/what-we-do/case-studies/kachumbala-maternity-unit/ [Accessed 22 October 2022].

HKS Architects, 2019. Kachumbala Maternity Unit, Kachumbala: HKS Architects. Landers, P., 2019. https://www.peterlanders.net/press. [Online] Available at: https://www.peterlanders.net/press [Accessed 22 October 2022].


Architect based in Milan, current student in Politecnico di Milano - AUD Master programme. Proactive participant in international and multidisciplinary teams with which he has achieved national and international recognition and co-authored several books on urban research and community development. Additionally, he is part of the Advanced School of Architecture, and he practices his profession in Milan, Mexico, and Ecuador.